Yoshikawa T, Hirano H, Araida T, Adzuma T, Ota T, Takasaki K
Department of Surgery, Tokyo Women's Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1997 May;98(5):501-4.
The surgical result in 74 patients with resected distal bile duct carcinoma was reviewed to clarify the surgical strategy of distal bile duct carcinoma. The clinicopathological record was according to the General rules for surgical and pathological studies on cancer of biliary tract(the 3rd edition, edited by the Japanese society of biliary surgery). 58 patients underwent standard pancreatoduodenectomy and 16 patients had pylorus-preserving pancreatoduodenectomy. The curative resection was performed in 38 patients (51.3%). The overall 5-year survival rate (operated death included) was 35.8%. The 5-year survival rate in curative resection was 56.6%. The survival rate of patients with curative resection was significantly better than that of the patients with relative non-curative (p < 0.05) or absolute non-curative resection (p < 0.01). We concluded that the Long-term survival after surgical resection was mostly correlated with curability. To obtain curative resection, the free surgical margin of hw and ew was essential. As for free "hw", intraoperative frozen dissection was indispensable. For free "ew", the dissection of the soft tissues in retroperitoneum at the back of pancreas head was necessary. On the lymph node dissection, the lymph nodes of No 8, 12, 13, 14 should be removed.
回顾74例接受远端胆管癌切除术患者的手术结果，以阐明远端胆管癌的手术策略。临床病理记录依据《胆道癌外科及病理研究总则》（第3版，由日本胆道外科学会编辑）。58例患者接受标准胰十二指肠切除术，16例患者接受保留幽门的胰十二指肠切除术。38例患者（51.3%）进行了根治性切除。总体5年生存率（包括手术死亡）为35.8%。根治性切除患者的5年生存率为56.6%。根治性切除患者的生存率显著优于相对非根治性（p<0.05）或绝对非根治性切除患者（p<0.01）。我们得出结论，手术切除后的长期生存大多与可治愈性相关。为实现根治性切除，肝门和肝外胆管切缘阴性至关重要。对于肝门切缘阴性，术中冰冻切片检查必不可少。对于肝外胆管切缘阴性，需在胰头后方的腹膜后进行软组织解剖。关于淋巴结清扫，应切除第8、12、13、14组淋巴结。
